Admission plasma levels of the neuronal injury marker neuron-specific enolase are associated with mortality and delirium in sepsis

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• 作者：Brian J. Anderson ; MD ; MS^a ; ^b ; ^{brian.anderson@uphs.upenn.edu" class="auth_mail" title="E-mail the corresponding author} ; John P. Reilly ; MD ; MS^a ; Michael G.S. Shashaty ; MD ; MS^a ; ^b ; Jessica A. Palakshappa ; MD^a ; ^b ; Alex Wysoczanski^a ; Thomas G. Dunn ; BA^a ; Altaf Kazi ; PhD^a ; Anna Tommasini ; BA^a ; Mark E. Mikkelsen ; MD ; MS^a ; ^b ; William D. Schweickert ; MD^a ; Dennis L. Kolson ; MD ; PhD^c ; Jason D. Christie ; MD ; MS^a ; ^b ; ¹ ; Nuala J. Meyer ; MD ; MS^a ; ¹
• 关键词：Sepsis ; Critical care ; Brain injury ; Delirium ; Neuron-specific enolase
• 刊名：Journal of Critical Care
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：36
• 期：Complete
• 页码：18-23
• 全文大小：342 K

文摘

Neuron-specific enolase (NSE) concentrations are prognostic following traumatic and anoxic brain injury and may provide a method to quantify neuronal injury in other populations. We determined the association of admission plasma NSE concentrations with mortality and delirium in critically ill septic patients.

Methods

We performed a retrospective analysis of 124 patients from a larger sepsis cohort. Plasma NSE was measured in the earliest blood draw at intensive care unit admission. Primary outcomes were 30-day mortality and intensive care unit delirium determined by chart review.

Results

Sixty-one patients (49.2%) died within 30 days, and delirium developed in 34 (31.5%) of the 108 patients who survived at least 24 hours and were not persistently comatose. Each doubling of the NSE concentration was associated with a 7.3% (95% confidence interval [CI] 2.5-12.0, P= .003) increased risk of 30-day mortality and a 5.2% (95% CI 3.2-7.2, P< .001) increased risk of delirium. An NSE concentration >12.5 μg/L was independently associated with a 23.3% (95% CI 6.7-39.9, P= .006) increased risk of 30-day mortality and a 29.3% (95% CI 8.8-49.8, P= .005) increased risk of delirium.

Conclusions

Higher plasma NSE concentrations were associated with mortality and delirium in critically ill septic patients, suggesting that NSE may have utility as a marker of neuronal injury in sepsis.